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There's only one profession in which students who graduate from an advanced learning program and who pass all the required exams are barred from employment due to bureaucratic red tape and predatory immigration policies. That profession is medical doctor.
Under the current system, in order to practice medicine, a medical school graduate must match to a residency position at a U.S. teaching hospital. If they don't match and complete their residency, they cannot practice medicine.
Decades ago, earning an MD degree practically guaranteed one could practice medicine. That's less and less the case, as nearly 5,000 doctors heard last week from the National Resident Matching Program (NRMP) that they went unmatched. That number includes 2,364 doctors graduating from U.S. medical schools in 2023 or earlier and 2,590 U.S. citizens graduating from international medical schools in 2023 or earlier.
And the phenomenon isn't new; similar shortfalls of U.S. taxpayer-funded residencies have occurred in previous years.
The NRMP, a private, non-profit organization established to provide an orderly and fair mechanism for matching the preferences of residency applicants to the preferences of residency program directors, touts a 93 to 94 percent match rate for current year graduates of U.S. medical schools. That may sound high, but the flip side is the remaining 6 to 7 percent of doctors who don't match, who are stuck in professional limbo. The New York Times estimated that there were over 10,000 qualified doctors who effectively can't practice medicine in America. U.S. citizens graduating from international medical schools are faced with even steeper odds: Only 67.6 percent matched in 2023.
Ironically, the number of foreign born doctors that the U.S. is importing—who are getting U.S. taxpayer-funded residencies—is on the rise. Since 2011, the number has risen from 2,721 to 5,032. So while American doctors languish without work, we are giving away good residencies and good jobs to foreigners.
Foreign born physicians arrive via the H-1B visa program to work directly in hospitals. In 2020, 3,508 labor condition applications (LCAs) were filed for 4,252 workers for the occupation of medical doctor, of which fully 3,004 were approved. Another 5,232 applications to extend from prior years were approved.
Every other country but the U.S. prioritizes its citizens in the pipeline to becoming a doctor. Canada, the last holdout, recently changed its policy to prioritize Canadian citizens and permanent legal residents over foreign born doctors.
But in the U.S., we've done the opposite, abandoning thousands of medical school graduates to conclude their academic careers with a virtually useless degree and in the process rack up huge debt. According to the Association of American Medical Colleges (AAMC), in 2019, the median medical school debt was $200,000.
And application fees for residencies drive the indebtedness even further. While graduates who match to a residency generally go on to earn an average annual salary of $200,000 to help pay down their debts, unmatched doctors don't have a plan B. They're left to fend for themselves and often forced to settle for hourly wages.
Dr. Doug Medina, a 2011 Georgetown University School of Medicine graduate with a doctorate in allopathic medicine, is an example of a qualified but unmatched doctor. As Dr. Medina explained in an interview, his skill set is "specific to one job and if I am not doing that job, I'm either under qualified for other jobs or overqualified."
Dr. Medina passed his clinical training and all his medical school coursework, earned honors in five acting Internship clinical rotations in his final year of medical school, passed the United States Medical Licensing Exam (USMLE) Steps 1, 2 and 3, and his research has been published at the Research Institute on Addictions. Notwithstanding those achievements, the matching hurdle prevented Dr. Medina from getting a job practicing medicine.
Banishing U.S. citizen MDs to the sidelines is inexplicable given how many patients across the country can't get care. We just don't have enough doctors, and the doctors who serve us are overburdened and exhausted. For years, the AAMC has warned of a dire physician shortage, predicting that by 2033, the nation will be understaffed by up to 124,000 physicians in both primary and specialty care.
Yet there are thousands of qualified, but unmatched U.S. doctors currently being barred from practicing for purely bureaucratic reasons. But there are solutions, both short and long term, that could be implemented and would go a long way toward putting American doctors to work.
First and foremost, American doctors should be prioritized in the Supplemental Offer Acceptance Program (SOAP). The SOAP affords doctors who did not match in the Main Residency Match to apply for residency positions that went unfilled during the initial match.
Another short-term solution is to provide medical malpractice coverage for doctors who did not match and who are looking for ways to enhance their clinical experience while waiting for the next year's match.
Longer-term, we should reduce the number of nonimmigrant visa holders filling resident physician positions and entering the country through programs like the J-1, a cultural exchange program, and the H-1B, a nonimmigrant work visa program. A reduction by 25 percent alone would ensure that every senior medical student who graduated from a U.S. school would be placed in a residency program.
There's no physician shortage. We have thousands of physicians in the line waiting for residency training. We need more residency positions so we can prioritize U.S. citizens and lawful permanent resident medical school graduates.
Kevin Lynn is the Executive Director of the Institute for Sound Public Policy and the Founder of U.S. Tech Workers. Lynn writes about the role that the nonimmigrant employment visa system has on skilled white-collar workers. He is based in Pennsylvania. Contact him at klynn at ifspp dot org.
The views expressed in this article are the writer's own.
